Provider Demographics
NPI:1093210767
Name:COOPER, STEVEN (LCSW)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:COOPER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 BAILIE LN
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30705-7331
Mailing Address - Country:US
Mailing Address - Phone:706-934-1816
Mailing Address - Fax:
Practice Address - Street 1:710 S THORNTON AVE STE F
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-8421
Practice Address - Country:US
Practice Address - Phone:706-934-1816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-26
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW0083191041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GANAOtherNA